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Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study



The closure of mucosal defects after colorectal endoscopic submucosal dissection (ESD) remains difficult. Therefore, various methods and devices have been developed to aid in this procedure. However, a standard method for mucosal defect closure after ESD has not been established. We aimed to examine the efficiency and safety of our clip-on-clip closure method (CCCM) after colorectal ESD.


The CCCM is a novel method for colorectal mucosal defect closure that uses a conventional clip on the handle of another clip, with the gap as an anchor. The CCCM was prospectively used for closing mucosal defects in 30 patients with 32 lesions after colorectal ESD at the Japanese Ise Red Cross Hospital, Yokkaichi Municipal Hospital, and Medical Corporation Yamashita Hospital between March 2018 and July 2018. Outcome measures were closure success rates of CCCM, procedural closure time, and postoperative adverse events.


The median resected specimen size was 34 mm (range 28–73 mm) and the median CCCM defect closure success rate was 97% (31/32). The median procedural time was 8 min (range 3.5–29.2 min), and the median number of clips used was 12 pieces (range 5–20). None of the patients had postoperative adverse events.


CCCM is an efficient, safe, and simple method for the closure of mucosal defects after colorectal ESD that can be performed using only conventional clips.

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Correspondence to Tatsuma Nomura.

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Drs. Tatsuma Nomura, Ippei Matsuzaki, Shinya Sugimoto, Jun Oyamda, Akira Kamei, and Makoto Kobayashi have no conflicts of interest or financial ties to disclose.

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Nomura, T., Matsuzaki, I., Sugimoto, S. et al. Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study. Surg Endosc 34, 1412–1416 (2020).

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  • Endoscopic submucosal dissection
  • Mucosal defect
  • Clip-on-clip closure method
  • CCCM